Individual
MR. KELLEN J PINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC, CES
Contact information
Practice address
12200 LOMAS BLVD NE, ALBUQUERQUE, NM 87112-5804
(505) 559-2200
Mailing address
4500 SHADOW AVE NW, ALBUQUERQUE, NM 87114-5063
(505) 681-0748
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
424
NM
Other
Enumeration date
08/07/2019
Last updated
08/07/2019
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